Ozempic could change the economy as we know it
businessinsider.com
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There were major weight related health complications I was having at 34 BMI and they're not happening now. I knew how to lose weight -- meticulously track every calorie, use diet and exercise to hit targets. I had done it before , down to -10% and -25% body mass twice in the past ten years. But it never stayed that way -- I found it incredibly hard to stick to my kcal in goal or to stay at a stable lower weight. I'd eat when I was hungry, and eat enough to stay at my long term stable weight. If I ever stopped tracking every calorie in, my default sense of "full" tended towards a caloric surplus.
This drug fills exactly the gap I was struggling to fill with previous attempts at weight loss. I've felt "full" at 1500 kcal/day for months (though have had more of an appetite in the past 1-2 months) and have ended almost every day with a caloric deficit. It's a serious pharmaceutical intervention and I read the literature on GLP-1 agonists for years before starting. There were side effects, notably reflux when eating too much, "sulfur burps", and a general feeling of malaise for the day after taking a dose for the first few months.
No idea what the long term consequences of staying on this drug forever will be. Haven't noticed any other behavior changes. Not particularly interested in the appearance angle (I felt like I looked okay before and look okay now, though I've needed new clothes due to dramatic changes in waist size).
But the health stuff is serious and real and if we can make this drug cheaply available to people who discuss it carefully with a doctor there is potential for a serious chronic disorder to be addressed much more effectively than it used to be.
How are you handling nutritional requirements? Do you take a bunch of supplements? Are you loading up on protein?
>There were major weight related health complications I was having at 34 BMI and they're not happening now.
I also experience a lot of health complications past certain weight, but I find it's more correlated to my bodyfat than BMI. Reflux and other issues I use to experience at 27 BMI @ 30%bodyfat, I start feeling at 32 BMI @20% bodyfat after building a lot of muscle. Difference between 27BMI @ 170lbs and 32BMI @200lb for me is ~30lbs. And the caloric difference between 170lb sedentary life style where my body starts acting up and 200lb 1-3x per week exercise life style where I don't is over 600 calories, which opens up a lot of dietary flexiblity in my life. Looking better is plus. But also just eating more than what I was during my obesse days and have good energy all the time. That said if I get to 205lbs all those symptoms come rushing back. I can see myself and others going on ozempic route if it's a means to nudge baseline weight below health complication effects. But hard to imagine phases of being on such big deficits.
Intuition tells me effective diet pills are excellent crutches at not building habits. Seems like recipe for yoyo pilling, which to be fair isn't unlike seasonal dietting except pills make the dietting part predictable. Gut feeling is still massively accessible diet pills is net good in terms of public health if it reduces all the conditions associated to being overweight.
IIRC, stomachs are fairly elastic, and so can expand. If one consumes/d larger volumes for an extended period of time then that stretch could perhaps become permanent (AIUI), so to actually feel full you have to consume more—which then the rest of one's body has to deal with.
It's one of the things that gastric bands can help with, and also sleeve gastrectomy.
For a start, it does not appear to be psychoactive to any large degree, which is a huge difference. Of course there will be psychological effects from anything that changes your weight or lifestyle rapidly, but that's not the same as being psychoactive.
I think the largest issue will be sorting out the genuine side effects of the drug from the side effects that would happen from any major change in lifestyle/weight.
Here's the list of side effects from wikipedia:
> Possible side effects include nausea, diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, indigestion/heartburn, dizziness, abdominal distension, belching, hypoglycemia (low blood glucose) in patients with type 2 diabetes, flatulence, gastroenteritis, and gastroesophageal reflux disease (GERD).[26] It can also cause pancreatitis, gastroparesis, and bowel obstruction.[27]
https://en.wikipedia.org/wiki/Semaglutide
How many of the things in that list would you say a person who undergoes massive weight loss in short time without drugs would experience? Or massive changes in the amount and type of food that they eat? Especially if they also have complications with diabetes or pre-diabetes.
And also, how do these compare to the inevitable health problems that long term obesity will cause the same person if they don't take the drug?
These questions will not be easy question to answer. I expect to see a lot of arguments from both sides in the coming years.
Did you know that being in the BMI “overweight” category is healthier than any other category, including “healthy” and “underweight”?
https://www.sciencealert.com/the-healthiest-weight-might-act...
Now you might say well that’s interesting but i was talking about obese people taking this drug.
“The study also found that those in the 'obese' category ended up having the same risk of death as those in the 'normal' range, even when factors such as age, sex, family history of disease, socio-economic status, and smoking were taken into account.”
So there are plenty of justifications and reasons to take a drug like this - some good, some bad - but hand waving at the obvious dangers of being overweight or obese doesn’t hold up as well as you might think.
I think we don't believe this anymore? I am linking to some Hacker News discussions as this is the only website I use (lol).
https://news.ycombinator.com/item?id=34930641
https://news.ycombinator.com/item?id=35121904
> Key Takeaways:
> Epidemiology researchers repeatedly have found that being overweight or obese is not as much of a mortality risk as conventional wisdom would suggest.
> Critics have contended that this "obesity paradox" is the result of poor methods. Using body-mass index (BMI) to measure obesity is likely the most problematic factor.
> Recent research that adjusts for the flaws inherent in BMI show that there is no paradox. The more body fat a person has, the more likely it is that they will die.
The study that you link to that suggests this makes absolutely zero attempts to control for wealth. I don’t think I need to take a health study in the USA seriously if it doesn’t consider the potential for wealth (access to healthcare, leisure time, poverty stress, etc) to be the cause of what it’s seeing.
All large scale observational studies are subject so such biases, and the one you linked to also seems a likely suspect there. The hidden confounders are pretty much infinite. The users of many of the worst of sorts of drugs, such as heroine and amphetamines, tend to be average to lower weight. They will die disproportionately young, which will drag their weight cohort substantially down. Another could be increases in things like body building, which show increases in BMI without the corresponding increase in body fat that it's supposed to represent.
I'm not saying any of these are the silver bullet, but rather that when you see a big observational study like this, that sort of skepticism should be the first thing to enter into your mind, as it's extremely often the case when you read about a [shocking discovery] based on big observational studies. Correlation is not causation, even with really big population sizes.
> The users of many of the worst of sorts of drugs, such as heroine and amphetamines, tend to be average to lower weight. They will die disproportionately young, which will drag their weight cohort substantially down.
Right so this study was skewed by meth use, something that there’s a good chance they controlled for at least where they could, but other studies couldn’t possibly be skewed by drugs that cause weight gain and shorten lifespan.
My takeaway from this and similar studies is that body fat (especially as categorized by BMI) is mostly orthogonal to health. It’s possible to be fat + healthy, fat + unhealthy, slim + healthy, and slim and unhealthy.
And if that’s the case, burdening fat people with my own assumptions about their health is misguided, and dumb.
And most often that answer is eventually found to be that [shocking discovery] was just reporting on a false correlation, driven by a confounding variable. It's the exact same here. There are countless extremely negative factors that being overweight weighs strongly into, yet somehow being overweight is good for life expectancy? There needs to be an explanation for why and, absent some revolutionary new discovery, by far the most likely explanation is a confounding variable.
[1] - https://jamanetwork.com/journals/jama/fullarticle/2520627
But the overarching point is: why is your default that fat is unhealthy and you must have bulletproof data to believe otherwise? My default is i don’t know one way or the other and I think health is probably way more complex than what % body fat you have and I don’t understand why so many people are determined to use it as a proxy for health.
Very good things do happen in this field!
[0] https://www.reuters.com/investigates/special-report/health-o...
This led to a dramatic drop in drug use. Big Pharma, in the quest to restoe its profits, pivoted to children.
Child fidgety? Can't pay attention? ADDERALL!
The episode is based on the author's first-person experience. I won't spoil the big reveal.
At least it was a step up 1940s ads:
Child fidgety? Can't pay attention? LOBOTOMY!Are your feelings on this influenced by the notion that obesity is a moral failing or a willpower issue?
We could argue about whether either is "cured" or just "in remission", but it's illogical to say one is cured and the other isn't.
Anything that measurably reverses the insane growth rate of obesity is very welcome.
If all it takes is a weekly shot to reliably improve individual decision making with consumption then that would legitimately be revolutionary.
No free lunch still applies though, I’ll be interested to see what the long term externalities are.
One interesting difference between Ozempic and accutane is that the accutane treatment is pretty much permanent after a dosage round but it seems like this Ozempic needs to be continuously taken to see effects. Which is great news for pharm companies
https://www.fiercebiotech.com/research/fractyls-gene-therapy...
https://www.fractyl.com/fractyl-health-demonstrated-signific...
I began to eat fewer calories of higher quality food, hit my macros, and prevented muscle loss by going to the gym a few times a week.
It was a feedback loop with my social environment. Expectations of me changed when I finished school, and I didn't really think anything of it until I saw some results which only reinforced the new habits. Everyone was supportive and from there lots of other stuff in my life got cleaned up as well. I don't even drink as much as I used to.
I can't be alone in feeling this way. For me it was finding good people, being happy with my career, and not being so stressed out all the time as a result.
But every discussion of ozempic inevitably brings up “ozempic face” which is some apparent aging and irreversible damage done to the skin/collagen.
So are we really changing the economy after obesity or are we just substituting one type of self-image issue with another, more difficult to treat one?
Weight loss body image issues often have nothing to do with obesity
I don't see the connection unless the ones producing the drug are getting all that money and buying new 3rd homes with custom furniture, new vehicles, etc. Since insurance evidently doesn't cover this for everyone there will be a lot of people paying ridiculous money to lose weight who will then be stuck on the lifetime drug treadmill as a health maintenance requirement drug.
Why don't we invest the money going to this expense in health education and public facilities for health maintenance - parks, gyms, etc.
I understand that many are already morbidly obese and need something like this drug to get them back in control of their own health outcomes but the overall goal should be to shed the extra weight and discontinue the drug while adopting healthy lifestyle habits.
How much does being obese cost the average person in healthcare?
I'd be surprised if it was A LOT less.
There's all kinds of opportunity costs to being unhealthy.
Plus, i completely quit drinking. Was never trying to even going to, i just didn't feel like drinking at all anymore about a month into it.
I'm a healthy weight. But it's only because I eat one meal a day and feel terribly hungry the entire day. When I eat more than once a day I balloon up into the obese category. So I am a good candidate for these treatments despite currently being in the low end of "normal" BMI.
Thankfully, my metabolism is not too bad. Not as good as my siblings who are all skinny but given how much I eat and given that I'm approaching middle age, I really can't complain.
I'm guessing you didn't get the covid-19 shots.